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hicpac guideline

Guideline for Prevention of Catheter-Associated

Urinary Tract Infections 2009
Carolyn V. Gould, MD, MSCR; Craig A. Umscheid, MD, MSCE; Rajender K. Agarwal, MD, MPH;
Gretchen Kuntz, MSW, MSLIS; David A. Pegues, MD; and the Healthcare Infection Control
Practices Advisory Committee (HICPAC)

editors note
Following are the Executive Summary, Summary of Recommendations, and Implementation and Audit sections. The
references for the entire guideline are available in the online
edition of the journal. The entire guideline and the full citation apparatus have been previously published by HICPAC
and are available at http://www.cdc.gov/hicpac/.

I. executive s ummary
This guideline updates and expands the original Centers
for Disease Control and Prevention (CDC) Guideline for
Prevention of Catheter-Associated Urinary Tract Infections
(CAUTI) published in 1981. Several developments necessitated revision of the 1981 guideline, including new research
and technological advancements for preventing CAUTI, increasing need to address patients in nonacute care settings
and patients requiring long-term urinary catheterization, and
greater emphasis on prevention initiatives as well as better
defined goals and metrics for outcomes and process measures.
In addition to updating the previous guideline, this revised
guideline reviews the available evidence on CAUTI prevention
for patients requiring chronic indwelling catheters and individuals who can be managed with alternative methods of
urinary drainage (eg, intermittent catheterization). The revised guideline also includes specific recommendations for
implementation, performance measurement, and surveillance. Although the general principles of CAUTI prevention
have not changed from the previous version, the revised
guideline provides clarification and more specific guidance
based on a defined, systematic review of the literature through
July 2007. For areas where knowledge gaps exist, recommendations for further research are listed. Finally, the revised
guideline outlines high-priority recommendations for CAUTI
prevention in order to offer guidance for implementation.
This document is intended for use by infection prevention

staff, healthcare epidemiologists, healthcare administrators,

nurses, other healthcare providers, and persons responsible
for developing, implementing, and evaluating infection prevention and control programs for healthcare settings across
the continuum of care. The guideline can also be used as a
resource for societies or organizations that wish to develop
more detailed implementation guidance for prevention of
CAUTI.
Our goal was to develop a guideline based on a targeted
systematic review of the best available evidence, with explicit
links between the evidence and recommendations. To accomplish this, we used an adapted GRADE system approach for
evaluating quality of evidence and determining strength of
recommendations. The methodology, structure, and components of this guideline are approved by HICPAC and will
be used for subsequent guidelines issued by HICPAC. A more
detailed description of our approach is available in the Methods section.
To evaluate the evidence on preventing CAUTI, we examined data addressing three key questions and related
subquestions:
1. Who should receive urinary catheters?
A. When is urinary catheterization necessary?
B. What are the risk factors for CAUTI?
C. What populations are at highest risk of mortality
related to urinary catheters?
2. For those who may require urinary catheters, what
are the best practices?
Specifically, what are the risks and benefits associated with:
A. Different approaches to catheterization?
B. Different catheters or collecting systems?
C. Different catheter management techniques?
D. Different systems interventions (ie, quality improvement programs)?

From the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (C.V.G.); the Center for EvidenceBased Practice, University of Pennsylvania Health System, Philadelphia (C.A.U., R.K.A., G.K. ); and the Division of Infectious Diseases, David Geffen School
of Medicine at University of California, Los Angeles (D.A.P.). Members of HICPAC are listed at the end of the text.
Received November 23, 2009; accepted November 23, 2009; electronically published February 15, 2010.
This article is in the public domain, and no copyright is claimed. 0899-823X/2010/3104-0001. DOI: 10.1086/651091

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table 1. Modified HICPAC Categorization Schemea for Recommendations

Category IA
Category IB

Category IC
Category II
No recommendation/unresolved issue
a
b

A strong recommendation supported by high to moderate qualityb evidence suggesting net

clinical benefits or harms
A strong recommendation supported by low quality evidence suggesting net clinical benefits
or harms or an accepted practice (eg, aseptic technique) supported by low to very low
quality evidence
A strong recommendation required by state or federal regulation
A weak recommendation supported by any quality evidence suggesting a trade-off between
clinical benefits and harms
Unresolved issue for which there is low to very low quality evidence with uncertain trade
offs between benefits and harms

Please refer to Methods (p 32) for implications of Category designations.

Please refer to Methods (p 2930) for process used to grade quality of evidence.

3. What are the best practices for preventing CAUTI

associated with obstructed urinary catheters?
Evidence addressing the key questions was used to formulate recommendations, and explicit links between the evidence and recommendations are available in the Evidence
Review in the body of the guideline and Evidence Tables and
GRADE Tables in the Appendices. It is important to note
that Category I recommendations are all considered strong
recommendations and should be equally implemented; it is
only the quality of the evidence underlying the recommendation that distinguishes between levels A and B. Category
IC recommendations are required by state or federal regulation and may have any level of supporting evidence. The
categorization scheme used in this guideline is presented in
Table 1 in the Summary of Recommendations and described
further in the Methods section.
The Summary of Recommendations is organized as follows: (1) recommendations for who should receive indwelling
urinary catheters (or, for certain populations, alternatives to
indwelling catheters); (2) recommendations for catheter insertion; (3) recommendations for catheter maintenance; (4)
quality improvement programs to achieve appropriate placement, care, and removal of catheters; (5) administrative infrastructure required; and (6) surveillance strategies.
The Implementation and Audit section includes a prioritization of recommendations (ie, high-priority recommendations that are essential for every healthcare facility), organized by modules, in order to provide facilities more
guidance on implementation of these guidelines. A list of
recommended performance measures that can potentially be
used for internal reporting purposes is also included.
Areas in need of further research identified during the
evidence review are outlined in the Recommendations for
Further Research. This section includes guidance for specific
methodological approaches that should be used in future
studies.
Readers who wish to examine the primary evidence underlying the recommendations are referred to the Evidence
Review in the body of the guideline, and the Evidence Tables
and GRADE Tables in the Appendices. The Evidence Review

includes narrative summaries of the data presented in the

Evidence Tables and GRADE Tables. The Evidence Tables
include all study-level data used in the guideline, and the
GRADE Tables assess the overall quality of evidence for each
question. The Appendices also contain a clearly delineated
search strategy that will be used for periodic updates to ensure that the guideline remains a timely resource as new information becomes available.

table 2. Examples of Appropriate and Inappropriate Indications for Indwelling Urethral Catheter Use
A. Examples of appropriate indications for indwelling urethral
catheter use
Patient has acute urinary retention or bladder outlet
obstruction
Need for accurate measurements of urinary output in critically ill patients
Perioperative use for selected surgical procedures:
Patients undergoing urologic surgery or other surgery on
contiguous structures of the genitourinary tract
Anticipated prolonged duration of surgery (catheters inserted for this reason should be removed in post-anesthesia care unit)
Patients anticipated to receive large-volume infusions or diuretics during surgery
Need for intraoperative monitoring of urinary output
To assist in healing of open sacral or perineal wounds in incontinent patients
Patient requires prolonged immobilization (eg, potentially unstable thoracic or lumbar spine, multiple traumatic injuries
such as pelvic fractures)
To improve comfort for end-of-life care if needed
B. Examples of inappropriate uses of indwelling catheters
As a substitute for nursing care of the patient or resident
with incontinence
As a means of obtaining urine for culture or other diagnostic
tests when the patient can voluntarily void
For prolonged postoperative duration without appropriate indications (eg, structural repair of urethra or contiguous
structures, prolonged effect of epidural anaesthesia, etc)
note.

These indications are based primarily on expert consensus.

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II. summary o f recommendations

I. Appropriate Urinary Catheter Use
A. Insert catheters only for appropriate indications (see
Table 2 for guidance), and leave in place only as long as
needed. (Category IB) (Key Questions 1B and 2C)
1. Minimize urinary catheter use and duration of use
in all patients, particularly those at higher risk for CAUTI
or mortality from catheterization such as women, the
elderly, and patients with impaired immunity. (Category
IB) (Key Questions 1B and 1C)
2. Avoid use of urinary catheters in patients and nursing home residents for management of incontinence.
(Category IB) (Key Question 1A)
a. Further research is needed on periodic (eg,
nighttime) use of external catheters (eg, condom catheters) in incontinent patients or residents and the use
of catheters to prevent skin breakdown. (No recommendation/unresolved issue) (Key Question 1A)
3. Use urinary catheters in operative patients only as
necessary, rather than routinely. (Category IB) (Key
Question 1A)
4. For operative patients who have an indication for
an indwelling catheter, remove the catheter as soon as
possible postoperatively, preferably within 24 hours, unless there are appropriate indications for continued use.
(Category IB) (Key Questions 2A and 2C)
B. Consider using alternatives to indwelling urethral
catheterization in selected patients when appropriate.
1. Consider using external catheters as an alternative
to indwelling urethral catheters in cooperative male patients without urinary retention or bladder outlet obstruction. (Category II) (Key Question 2A)
2. Consider alternatives to chronic indwelling catheters, such as intermittent catheterization, in spinal cord
injury patients. (Category II) (Key Question 1A)
3. Intermittent catheterization is preferable to indwelling urethral or suprapubic catheters in patients
with bladder emptying dysfunction. (Category II) (Key
Question 2A)
4. Consider intermittent catheterization in children
with myelomeningocele and neurogenic bladder to reduce the risk of urinary tract deterioration. (Category
II) (Key Question 1A)
5. Further research is needed on the benefit of using
a urethral stent as an alternative to an indwelling catheter
in selected patients with bladder outlet obstruction. (No
recommendation/unresolved issue) (Key Question 1A)
6. Further research is needed on the risks and benefits
of suprapubic catheters as an alternative to indwelling
urethral catheters in selected patients requiring shortor long-term catheterization, particularly with respect to
complications related to catheter insertion or the cath-

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eter site. (No recommendation/unresolved issue) (Key

Question 2A)
II. Proper Techniques for Urinary Catheter Insertion
A. Perform hand hygiene immediately before and after
insertion or any manipulation of the catheter device or
site. (Category IB) (Key Question 2D)
B. Ensure that only properly trained persons (eg, hospital personnel, family members, or patients themselves)
who know the correct technique of aseptic catheter insertion and maintenance are given this responsibility. (Category IB) (Key Question 1B)
C. In the acute care hospital setting, insert urinary catheters using aseptic technique and sterile equipment. (Category IB)
1. Use sterile gloves, drape, sponges, an appropriate
antiseptic or sterile solution for periurethral cleaning,
and a single-use packet of lubricant jelly for insertion.
(Category IB)
2. Routine use of antiseptic lubricants is not necessary. (Category II) (Key Question 2C)
3. Further research is needed on the use of antiseptic
solutions versus sterile water or saline for periurethral
cleaning prior to catheter insertion. (No recommendation/unresolved issue) (Key Question 2C)
D. In the nonacute care setting, clean (ie, nonsterile)
technique for intermittent catheterization is an acceptable
and more practical alternative to sterile technique for patients requiring chronic intermittent catheterization. (Category IA) (Key Question 2A)
1. Further research is needed on optimal cleaning and
storage methods for catheters used for clean intermittent
catheterization. (No recommendation/unresolved issue)
(Key Question 2C)
E. Properly secure indwelling catheters after insertion
to prevent movement and urethral traction. (Category IB)
F. Unless otherwise clinically indicated, consider using
the smallest bore catheter possible, consistent with good
drainage, to minimize bladder neck and urethral trauma.
(Category II)
G. If intermittent catheterization is used, perform it at
regular intervals to prevent bladder overdistension. (Category IB) (Key Question 2A)
H. Consider using a portable ultrasound device to assess
urine volume in patients undergoing intermittent catheterization to assess urine volume and reduce unnecessary
catheter insertions. (Category II) (Key Question 2C)
1. If ultrasound bladder scanners are used, ensure that
indications for use are clearly stated, nursing staff are
trained in their use, and equipment is adequately cleaned
and disinfected in between patients. (Category IB)
III. Proper Techniques for Urinary Catheter Maintenance
A. Following aseptic insertion of the urinary catheter,

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maintain a closed drainage system. (Category IB) (Key

Question 1B and 2B)
1. If breaks in aseptic technique, disconnection, or
leakage occur, replace the catheter and collecting system
using aseptic technique and sterile equipment. (Category
IB)
2. Consider using urinary catheter systems with preconnected, sealed catheter-tubing junctions. (Category
II) (Key Question 2B)
B. Maintain unobstructed urine flow. (Category IB)
(Key Questions 1B and 2D)
1. Keep the catheter and collecting tube free from
kinking. (Category IB)
2. Keep the collecting bag below the level of the bladder at all times. Do not rest the bag on the floor. (Category IB)
3. Empty the collecting bag regularly using a separate,
clean collecting container for each patient; avoid splashing, and prevent contact of the drainage spigot with the
nonsterile collecting container. (Category IB)
C. Use Standard Precautions, including the use of gloves
and gown as appropriate, during any manipulation of the
catheter or collecting system. (Category IB)
D. Complex urinary drainage systems (utilizing mechanisms for reducing bacterial entry such as antiseptic-release cartridges in the drain port) are not necessary for
routine use. (Category II) (Key Question 2B)
E. Changing indwelling catheters or drainage bags at
routine, fixed intervals is not recommended. Rather, it is
suggested to change catheters and drainage bags based on
clinical indications such as infection, obstruction, or when
the closed system is compromised. (Category II) (Key
Question 2C)
F. Unless clinical indications exist (eg, in patients with
bacteriuria upon catheter removal post urologic surgery),
do not use systemic antimicrobials routinely to prevent
CAUTI in patients requiring either short or long-term
catheterization. (Category IB) (Key Question 2C)
1. Further research is needed on the use of urinary
antiseptics (eg, methenamine) to prevent UTI in patients
requiring short-term catheterization. (No recommendation/unresolved issue) (Key Question 2C)
G. Do not clean the periurethral area with antiseptics
to prevent CAUTI while the catheter is in place. Routine
hygiene (eg, cleansing of the meatal surface during daily
bathing or showering) is appropriate. (Category IB) (Key
Question 2C)
H. Unless obstruction is anticipated (eg, as might occur
with bleeding after prostatic or bladder surgery) bladder
irrigation is not recommended. (Category II) (Key Question 2C)
1. If obstruction is anticipated, closed continuous irrigation is suggested to prevent obstruction. (Category II)

I. Routine irrigation of the bladder with antimicrobials

is not recommended. (Category II) (Key Question 2C)
J. Routine instillation of antiseptic or antimicrobial solutions into urinary drainage bags is not recommended.
(Category II) (Key Question 2C)
K. Clamping indwelling catheters prior to removal is
not necessary. (Category II) (Key Question 2C)
L. Further research is needed on the use of bacterial
interference (ie, bladder inoculation with a nonpathogenic
bacterial strain) to prevent UTI in patients requiring
chronic urinary catheterization. (No recommendation/unresolved issue) (Key Question 2C)
Catheter Materials
M. If the CAUTI rate is not decreasing after implementing a comprehensive strategy to reduce rates of
CAUTI, consider using antimicrobial/antisepticimpregnated catheters. The comprehensive strategy should include, at a minimum, the high priority recommendations
for urinary catheter use, aseptic insertion, and maintenance
(see Section III. Implementation and Audit). (Category IB)
(Key Question 2B)
1. Further research is needed on the effect of antimicrobial/antisepticimpregnated catheters in reducing
the risk of symptomatic UTI, their inclusion among the
primary interventions, and the patient populations most
likely to benefit from these catheters. (No recommendation/unresolved issue) (Key Question 2B)
N. Hydrophilic catheters might be preferable to standard catheters for patients requiring intermittent catheterization. (Category II) (Key Question 2B)
O. Silicone might be preferable to other catheter materials to reduce the risk of encrustation in long-term catheterized patients who have frequent obstruction. (Category
II) (Key Question 3)
P. Further research is needed to clarify the benefit of
catheter valves in reducing the risk of CAUTI and other
urinary complications. (No recommendation/unresolved
issue) (Key Question 2B)
Management of Obstruction
Q. If obstruction occurs and it is likely that the catheter
material is contributing to obstruction, change the catheter.
(Category IB)
R. Further research is needed on the benefit of irrigating
the catheter with acidifying solutions or use of oral urease
inhibitors in long-term catheterized patients who have frequent catheter obstruction. (No recommendation/unresolved issue) (Key Question 3)
S. Further research is needed on the use of a portable
ultrasound device to evaluate for obstruction in patients
with indwelling catheters and low urine output. (No recommendation/unresolved issue) (Key Question 2C)
T. Further research is needed on the use of methena-

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mine to prevent encrustation in patients requiring chronic

indwelling catheters who are at high risk for obstruction.
(No recommendation/unresolved issue) (Key Question
2C)
Specimen Collection
U. Obtain urine samples aseptically. (Category IB)
1. If a small volume of fresh urine is needed for examination (ie, urinalysis or culture), aspirate the urine
from the needleless sampling port with a sterile syringe/
cannula adapter after cleansing the port with a disinfectant. (Category IB)
2. Obtain large volumes of urine for special analyses
(not culture) aseptically from the drainage bag. (Category IB)
Spatial Separation of Catheterized Patients
V. Further research is needed on the benefit of spatial
separation of patients with urinary catheters to prevent
transmission of pathogens colonizing urinary drainage systems. (No recommendation/unresolved issue) (Key Question 2D)
IV. Quality Improvement Programs
A. Implement quality improvement (QI) programs or
strategies to enhance appropriate use of indwelling catheters and to reduce the risk of CAUTI based on a facility
risk assessment. (Category IB) (Key Question 2D)
The purposes of QI programs should be: (1) to assure
appropriate utilization of catheters, (2) to identify and remove catheters that are no longer needed (eg, daily review
of their continued need), and (3) to ensure adherence to
hand hygiene and proper care of catheters. Examples of
programs that have been demonstrated to be effective
include:
1. A system of alerts or reminders to identify all patients with urinary catheters and assess the need for
continued catheterization.
2. Guidelines and protocols for nurse-directed removal of unnecessary urinary catheters.
3. Education and performance feedback regarding appropriate use, hand hygiene, and catheter care.
4. Guidelines and algorithms for appropriate perioperative catheter management, such as:
a. Procedure-specific guidelines for catheter placement and postoperative catheter removal.
b. Protocols for management of postoperative urinary retention, such as nurse-directed use of intermittent catheterization and use of bladder ultrasound
scanners.
V. Administrative Infrastructure
A. Provision of guidelines

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1. Provide and implement evidence-based guidelines

that address catheter use, insertion, and maintenance.
(Category IB)
a. Consider monitoring adherence to facility-based
criteria for acceptable indications for indwelling urinary catheter use. (Category II)
B. Education and Training
1. Ensure that healthcare personnel and others who
take care of catheters are given periodic in-service training regarding techniques and procedures for urinary
catheter insertion, maintenance, and removal. Provide
education about CAUTI, other complications of urinary
catheterization, and alternatives to indwelling catheters.
(Category IB)
2. When feasible, consider providing performance
feedback to these personnel on what proportion of catheters they have placed meet facility-based criteria and
other aspects related to catheter care and maintenance.
(Category II)
C. Supplies
1. Ensure that supplies necessary for aseptic technique for catheter insertion are readily available. (Category IB)
D. System of documentation
1. Consider implementing a system for documenting
the following in the patient record: indications for catheter insertion, date and time of catheter insertion, individual who inserted catheter, and date and time of
catheter removal. (Category II)
a. Ensuring that documentation is accessible in the
patient record and recorded in a standard format for
data collection and quality improvement purposes is
suggested. Electronic documentation that is searchable
is preferable. (Category II)
E. Surveillance resources
1. If surveillance for CAUTI is performed, ensure that
there are sufficient trained personnel and technology
resources to support surveillance for urinary catheter
use and outcomes. (Category IB)
VI. Surveillance
A. Consider surveillance for CAUTI when indicated by
facility-based risk assessment. (Category II)
1. Identify the patient groups or units on which to
conduct surveillance based on frequency of catheter
use and potential risk of CAUTI.
B. Use standardized methodology for performing
CAUTI surveillance. (Category IB)
1. Examples of metrics that should be used for
CAUTI surveillance include:
a. Number of CAUTI per 1,000 catheter-days
b. Number of bloodstream infections secondary
to CAUTI per 1,000 catheter-days

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c. Catheter utilization ratio: (urinary catheter days/

patient days) x 100
2. Use CDC/NHSN criteria for identifying patients
who have symptomatic UTI (SUTI) (numerator data)
(see NHSN Patient Safety Manual: http://www.cdc.gov/
nhsn/library.html).
3. For more information on metrics, please see the
U.S. Department of Health & Human Services (HHS)
Action Plan to Prevent Healthcare-Associated Infections:
http://www.hhs.gov/ophs/initiatives/hai/infection.html.
C. Routine screening of catheterized patients for asymptomatic bacteriuria (ASB) is not recommended. (Category
II) (Key Question 2D)
D. When performing surveillance for CAUTI, consider
providing regular (eg, quarterly) feedback of unit-specific
CAUTI rates to nursing staff and other appropriate clinical
care staff. (Category II) (Key Question 2D)

III. i mplementation and audit

Prioritization of Recommendations
In this section, the recommendations considered essential for
all healthcare facilities caring for patients requiring urinary
catheterization are organized into modules in order to provide more guidance to facilities on implementation of these
guidelines. The high-priority recommendations were chosen
by a consensus of experts based on strength of recommendation as well as on the likely impact of the strategy in preventing CAUTI. The administrative functions and infrastructure listed above in the summary of recommendations are
necessary to accomplish the high priority recommendations
and are therefore critical to the success of a prevention program. In addition, quality improvement programs should be
implemented as an active approach to accomplishing these
recommendations and when process and outcome measure
goals are not being met based on internal reporting.
Priority Recommendations for Appropriate Urinary
Catheter Use (Module 1)
Insert catheters only for appropriate indications (see
Table 2), and leave in place only as long as needed.
(Category IB)
Avoid use of urinary catheters in patients and
nursing home residents for management of incontinence. (Category IB)
For operative patients who have an indication
for an indwelling catheter, remove the catheter
as soon as possible postoperatively, preferably
within 24 hours, unless there are appropriate
indications for continued use. (Category IB)
Priority Recommendations for Aseptic Insertion of
Urinary Catheters (Module 2)
Ensure that only properly trained persons (eg, hos-

pital personnel, family members, or patients themselves) who know the correct technique of aseptic
catheter insertion and maintenance are given this responsibility. (Category IB)
In the acute care hospital setting, insert catheters using aseptic technique and sterile equipment. (Category IB)
Priority Recommendations for Proper Urinary Catheter
Maintenance (Module 3)
Following aseptic insertion of the urinary catheter,
maintain a closed drainage system (Category IB)
Maintain unobstructed urine flow. (Category IB)
Performance Measures
A. Internal Reporting. Consider reporting both process
and outcome measures to senior administrative, medical,
and nursing leadership and clinicians who care for patients
at risk for CAUTI. (Category II)
1. Examples of process measures:
a. Compliance with educational program: Calculate percent of personnel who have proper training:
Numerator: number of personnel who insert urinary catheters and who have proper training
Denominator: number of personnel who insert urinary catheters
Standardization factor: 100 (ie, multiply by
100 so that measure is expressed as a
percentage)
b. Compliance with documentation of catheter insertion and removal dates: Conduct random audits
of selected units and calculate compliance rate:
Numerator: number of patients on unit with
catheters with proper documentation of insertion and removal dates
Denominator: number of patients on the unit
with a catheter in place at some point during
admission
Standardization factor: 100 (ie, multiply by
100 so that measure is expressed as a
percentage)
c. Compliance with documentation of indication
for catheter placement: Conduct random audits of
selected units and calculate compliance rate
Numerator: number of patients on unit with
catheters with proper documentation of
indication
Denominator: number of patients on the unit
with catheter in place
Standardization factor: 100 (ie, multiply by
100 so that measure is expressed as a
percentage)
2. Recommended outcome measures:

hicpac guideline

a. Rates of CAUTI: Use NHSN definitions (see

http://www.cdc.gov/nhsn/library.html). Measurement
of rates allows an individual facility to gauge the longitudinal impact of implementation of prevention
strategies:
Numerator: number of CAUTIs in each location
monitored
Denominator: total number of urinary catheterdays for all patients that have an indwelling urinary catheter in each location monitored
Standardization factor: Multiply by 1,000 so that
the measure is expressed as cases per 1,000 catheter-days
b. Rate of bloodstream infections secondary to
CAUTI: Use NHSN definitions for laboratory-confirmed bloodstream infection, available at http://
www.cdc.gov/nhsn/library.html.
Numerator: number of episodes of bloodstream
infections secondary to CAUTI
Denominator: total number of urinary catheterdays for all patients that have an indwelling urinary catheter in each location monitored
Standardization factor: Multiply by 1,000 so that
the measure is expressed as cases per 1,000 catheter-days
B. External Reporting. Current NHSN definitions for
CAUTI were developed for monitoring of rates
within a facility; however, reporting of CAUTI rates
for facility-to-facility comparison might be requested
by state requirements and external quality initiatives.

officers a nd members o f hicpac

Chair: Patrick J. Brennan, MD, Chief Medical Officer, Division of Infectious Diseases, University of Pennsylvania
Health System; Executive Secretary: Michael R. Bell, MD,
Associate Director for Infection Control, Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention. Members:
Lillian A. Burns, MPH, Infection Control Coordinator, Infectious Diseases Department, Greenwich Hospital; Alexis Elward, MD, MPH, Medical Director of Infection Control, Assistant Professor, Pediatric Infectious Diseases, Washington
University School of Medicine; Jeffrey Engel, MD, Chief, Epidemiology Section, North Carolina Division of Public
Health, North Carolina State Epidemiologist; Tammy Lundstrom, MD, JD, Chief Medical Officer, Providence Hospital;
Steven M. Gordon, MD, Chairman, Department of Infectious
Diseases, Hospital Epidemiologist, Cleveland Clinic Foundation; Yvette S. Mccarter, PhD, Director, Clinical Microbiology, Laboratory, Department of Pathology, University of
Florida Health Science, Center-Jacksonville; Denise M. Murphy, MPH, RN, CIC, Vice President, Safety and Quality,
Barnes-Jewish Hospital at Washington, University Medical
Center; Russell N. Olmsted, MPH, Epidemiologist, Infection

325

Control Services, St. Joseph Mercy Health System; David Alexander Pegues, MD, Professor of Medicine, Hospital Epidemiologist, David Geffen School of Medicine at UCLA; Keith
M. Ramsey, MD, Professor of Medicine, Medical Director of
Infection Control, Pitt County Memorial; Nalini Singh, MD,
MPH, Professor of Pediatrics, Epidemiology, and International Health, George Washington University Childrens National Medical Center; Barbara M. Soule, RN, MPA, CIC,
Practice Leader, Infection Prevention Services Joint Commission Resources/Joint Commission International; William
P. Schecter, MD, Department of Surgery, Ward 3A 17 San
Francisco General Hospital; Kurt Brown Stevenson, MD,
MPH, Division of Infectious Diseases, Department of Internal
Medicine, The Ohio State University Medical Center. Ex Officio Members: Agency for Healthcare Research and Quality
Ex-Officio, William B. Baine, MD, Senior Medical Advisor
Center for Outcomes and Evidence, Agency for Healthcare
Research and Quality; National Institute of Health Ex-Officio
David Henderson, MD, Deputy Director for Clinical Care,
National Institute of Health; Health Resources and Services
Administration Ex-Officio Lorine J. Jay, MPH, RN, CPHQ
Regional Coordinator; Food and Drug Administration ExOfficio Sheila A. Murphey, MD, Branch Chief, Infection Control Devices Branch, Division of Anesthesiology, General Hospital Infection Control and Dental Devices, Center for Devices
and Radiology Health, Food and Drug Administration; Center for Medicare & Medicaid Services (CMS) Ex-Officio Jeannie Miller, RN, MPH, Deputy Director, Office of Clinical
Standards and Quality/Clinical Standards Group; Department
of Veterans Affairs (VA) Gary A. Roselle, MD, National Program Director, Infectious Diseases, VA Central Office, Cincinnati VA Medical Center. Liaisons: Association of Professionals of Infection Control and Epidemiology, Nancy Bjerke,
BSN, RN, MPH, CIC, Infection Control Consultant, Infection
Control Associates; American Health Care Association, Sandra L. Fitzler, RN, Senior Director of Clinical Services, American Health Care Association; American College of Occupational and Environmental Medicine, Mark Russi, MD,
MPH, American College of Occupational and Environmental
Medicine; Advisory Council for the Elimination of Tuberculosis, Rachel L. Stricof, MPH, New York State Department
of Health; American Hospital Association, Roslyne Schulman,
MHA, MBA, Senior Associate Director, Policy Development;
Association of periOperative Registered Nurses, Joan C. Blanchard, RN, BSN, MSS, CNOR, CIC, Association of periOperative Registered Nurses; Society for Healthcare Epidemiology of America, Lisa Maragakis, MD, Assistant Professor
of Medicine, Johns Hopkins Medical Institutions; Joint Commission on Accreditation of Healthcare Organizations, Robert
A. Wise, MD, Division of Standards and Survey Methods,
Joint Commission on Accreditation of Healthcare Organizations; Consumers Union, Lisa Mcgiffert, Senior Policy Analyst on Health Issues, Project Director, Stop Hospital Infections Organization; and Council of State and Territorial

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april 2010, vol. 31, no. 4

Epidemiologists, Marion Kainer, MD, MPH, Medical Epidemiologist/Infections Diseases Physician Director, Hospital
Infections and Antimicrobial Resistance Program, Tennessee
Department of Health.

acknowledgments
HICPAC thanks the following members who served on the HICPAC CAUTI
Guideline subcommittee during the guideline development process: Russell
N. Olmsted, MPH; Yvette S. McCarter, PhD; Barbara M. Soule, RN, MPA,
CIC; and Nalini Singh, MD, MPH. HICPAC thanks the following outside

experts for reviewing a draft of this guideline: Edward S. Wong, MD; Lindsay
E. Nicolle, MD; Anthony J. Schaeffer, MD; and Harriett M. Pitt, RN, MS,
CIC. The opinions of the reviewers might not be reflected in all the recommendations contained in this document. HICPAC would also like to thank
the many individuals and organizations who provided valuable feedback on
the guideline during the public comment period.
Financial support. Centers for Disease Control and Prevention, to support
the guideline development process (to C.A.U. and R.K.A.).
Potential conflicts of interest. D.A.P. reports that he is on the speakers
bureau of Merck, Pfizer, Schering, and Cubist and is a consultant for Dow
Pharmaceuticals, DaVita, and Vasonova. All other authors report no conflicts
of interest relevant to this article.